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Patient-Perceived Barriers to Preventive Health Care Among Indigent, Rural Appalachian Patients

Patient-Perceived Barriers to Preventive Health Care Among Indigent, Rural Appalachian Patients Abstract Objective: To examine perceptions of a cohort of rural Appalachian patients regarding barriers to the use of preventive health measures. Methods: Consecutive new patients (N=188) at a clinic for the indigent were confidentially surveyed about their use of six preventive health measures: blood pressure screening, cholesterol level, diphtheria-tetanus immunization, mammography, cervical Papanicolaou smear, and physical examination. When any of these measures was lacking, patients were asked why, and whether they would have the measure performed if the relevant barriers were removed. Results: Applicable screening measures lacking were as follows: blood pressure screening, 16%; cholesterol level, 60%; diphtheria-tetanus immunization, 67%; mammography, 69%; Papanicolaou smear, 22%; and physical examination, 32%. Of the patients, 85% were lacking at least one measure. Patients most often identified the following reasons for having omitted these measures: lack of knowledge about prevention (51%) and cost (36%). Older and less educated patients more often identified cost (P<.01 and P=.06, respectively), and men were more likely to list lack of knowledge (P=.04). If the identified barriers could be removed, 72% of those lacking a screen indicated they would obtain the screening measures. Discussion: This indigent population expressed a desire for preventive care. Our patients identified cost and lack of knowledge as the major reasons for omitting these health screening measures. Data obtained from health care providers, rather than patients, may fail to disclose the barriers these patients face. Adequate education about disease prevention may be as crucial as sufficient funding in improving compliance with preventive guidelines.(Arch Intern Med. 1995;155:421-424) References 1. Woo B, Woo B, Cook EF, Weisberg M, Goldman L. Screening procedures in the asymptomatic adult: comparison of physicians' recommendations, patients' desires, published guidelines, and actual practice. JAMA . 1985;254: 1480-1484.Crossref 2. Lurie N, Manning WG, Peterson C, Goldberg GA, Phelps CA, Lillard L. Preventive care: do we practice what we preach? Am J Public Health . 1987;77: 801-804.Crossref 3. Burack RC. Barriers to clinical preventive medicine. Primary Care . 1989;16: 245-250. 4. Hayward RA, Shapiro MF, Freeman HE, Corey CR. Who gets screened for cervical and breast cancer? results from a new national survey. Arch Intern Med . 1988;148:1177-1181.Crossref 5. Woolhandler S, Himmelstein DU. Reverse targeting of preventive care due to lack of health insurance. JAMA . 1988;259:2872-2874.Crossref 6. Woolhandler S, Himmelstein DU. Resolving the cost/access conflict: the case for a national health program. J Gen Intern Med . 1989;4:54-60.Crossref 7. Dutton D. Financial, organizational and professional factors affecting health care utilization. Soc Sci Med . 1986;23:721-735.Crossref 8. Rowland D, Lyons B. Triple jeopardy: rural, poor, and uninsured. Health Serv Res . 1989;23:975-1003. 9. Love RR, Brown RL, Davis JE, Baumann LJ, Fontana SA, Sanner LA. Frequency and determinants of screening for breast cancer in primary care group practice. Arch Intern Med . 1993;153:2113-2117.Crossref 10. Margolis KL, Lurie N, McGovern PG, Slater JS. Predictors of failure to attend scheduled mammography appointments at a public teaching hospital. J Gen Intern Med . 1993;8:602-605.Crossref 11. Ayanian JZ, Kohler BA, Abe T, Epstein AM. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med . 1993;329:326-331.Crossref 12. Hahn RA, Teutsch SM, Rothenberg RB, Marks JS. Excess deaths from nine chronic diseases in the United States, 1986. JAMA . 1990;264:2654-2659.Crossref 13. Jubelier S, Baron R, Mairs D. Pap smear screening intervals among patients with cervical cancer in West Virginia. Adv Cancer Control . 1989;293:323-330. 14. Current trends: premature mortality in West Virginia 1978-1982. MMWR Morb Mortal Wkly Rep . 1987;36:29-33. 15. Weller JE. Yesterday's People: Life in Contemporary Appalachia . Lexington, Ky: University of Kentucky Press; 1965:116-120. 16. US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions . Baltimore, Md: Williams & Wilkins; 1989:xxix-lviii. 17. Hayward RS, Steinberg EP, Ford DE, Roizen MF, Roach KW. Preventive care guidelines: 1991. Ann Intern Med . 1991;114:758-783.Crossref 18. SAS Institute Inc. The CATMOD, FREQ, and NPAR1WAY procedures. In: SAS/ STAT User's Guide, Version 6.03 . Cary, NC: SAS Institute Inc; 1988:189-282, 519-548, 713-726. 19. Connell CM, Crawford CO. How people obtain their health information: a survey in two Pennsylvania counties. Public Health Rep . 1988;103:189-195. 20. Rimer BK, Keintz MK, Kessler HB, Engstrom PF, Rosan JR. Why women resist screening mammography: patient-related barriers. Radiology . 1989;172:243-246.Crossref 21. Belcher DW. Implementing preventive services: success and failure in an outpatient trial. Arch Intern Med . 1990;150:2533-2541.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Patient-Perceived Barriers to Preventive Health Care Among Indigent, Rural Appalachian Patients

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Publisher
American Medical Association
Copyright
Copyright © 1995 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1995.00430040097012
Publisher site
See Article on Publisher Site

Abstract

Abstract Objective: To examine perceptions of a cohort of rural Appalachian patients regarding barriers to the use of preventive health measures. Methods: Consecutive new patients (N=188) at a clinic for the indigent were confidentially surveyed about their use of six preventive health measures: blood pressure screening, cholesterol level, diphtheria-tetanus immunization, mammography, cervical Papanicolaou smear, and physical examination. When any of these measures was lacking, patients were asked why, and whether they would have the measure performed if the relevant barriers were removed. Results: Applicable screening measures lacking were as follows: blood pressure screening, 16%; cholesterol level, 60%; diphtheria-tetanus immunization, 67%; mammography, 69%; Papanicolaou smear, 22%; and physical examination, 32%. Of the patients, 85% were lacking at least one measure. Patients most often identified the following reasons for having omitted these measures: lack of knowledge about prevention (51%) and cost (36%). Older and less educated patients more often identified cost (P<.01 and P=.06, respectively), and men were more likely to list lack of knowledge (P=.04). If the identified barriers could be removed, 72% of those lacking a screen indicated they would obtain the screening measures. Discussion: This indigent population expressed a desire for preventive care. Our patients identified cost and lack of knowledge as the major reasons for omitting these health screening measures. Data obtained from health care providers, rather than patients, may fail to disclose the barriers these patients face. Adequate education about disease prevention may be as crucial as sufficient funding in improving compliance with preventive guidelines.(Arch Intern Med. 1995;155:421-424) References 1. Woo B, Woo B, Cook EF, Weisberg M, Goldman L. Screening procedures in the asymptomatic adult: comparison of physicians' recommendations, patients' desires, published guidelines, and actual practice. JAMA . 1985;254: 1480-1484.Crossref 2. Lurie N, Manning WG, Peterson C, Goldberg GA, Phelps CA, Lillard L. Preventive care: do we practice what we preach? Am J Public Health . 1987;77: 801-804.Crossref 3. Burack RC. Barriers to clinical preventive medicine. Primary Care . 1989;16: 245-250. 4. Hayward RA, Shapiro MF, Freeman HE, Corey CR. Who gets screened for cervical and breast cancer? results from a new national survey. Arch Intern Med . 1988;148:1177-1181.Crossref 5. Woolhandler S, Himmelstein DU. Reverse targeting of preventive care due to lack of health insurance. JAMA . 1988;259:2872-2874.Crossref 6. Woolhandler S, Himmelstein DU. Resolving the cost/access conflict: the case for a national health program. J Gen Intern Med . 1989;4:54-60.Crossref 7. Dutton D. Financial, organizational and professional factors affecting health care utilization. Soc Sci Med . 1986;23:721-735.Crossref 8. Rowland D, Lyons B. Triple jeopardy: rural, poor, and uninsured. Health Serv Res . 1989;23:975-1003. 9. Love RR, Brown RL, Davis JE, Baumann LJ, Fontana SA, Sanner LA. Frequency and determinants of screening for breast cancer in primary care group practice. Arch Intern Med . 1993;153:2113-2117.Crossref 10. Margolis KL, Lurie N, McGovern PG, Slater JS. Predictors of failure to attend scheduled mammography appointments at a public teaching hospital. J Gen Intern Med . 1993;8:602-605.Crossref 11. Ayanian JZ, Kohler BA, Abe T, Epstein AM. The relation between health insurance coverage and clinical outcomes among women with breast cancer. N Engl J Med . 1993;329:326-331.Crossref 12. Hahn RA, Teutsch SM, Rothenberg RB, Marks JS. Excess deaths from nine chronic diseases in the United States, 1986. JAMA . 1990;264:2654-2659.Crossref 13. Jubelier S, Baron R, Mairs D. Pap smear screening intervals among patients with cervical cancer in West Virginia. Adv Cancer Control . 1989;293:323-330. 14. Current trends: premature mortality in West Virginia 1978-1982. MMWR Morb Mortal Wkly Rep . 1987;36:29-33. 15. Weller JE. Yesterday's People: Life in Contemporary Appalachia . Lexington, Ky: University of Kentucky Press; 1965:116-120. 16. US Preventive Services Task Force. Guide to Clinical Preventive Services: An Assessment of the Effectiveness of 169 Interventions . Baltimore, Md: Williams & Wilkins; 1989:xxix-lviii. 17. Hayward RS, Steinberg EP, Ford DE, Roizen MF, Roach KW. Preventive care guidelines: 1991. Ann Intern Med . 1991;114:758-783.Crossref 18. SAS Institute Inc. The CATMOD, FREQ, and NPAR1WAY procedures. In: SAS/ STAT User's Guide, Version 6.03 . Cary, NC: SAS Institute Inc; 1988:189-282, 519-548, 713-726. 19. Connell CM, Crawford CO. How people obtain their health information: a survey in two Pennsylvania counties. Public Health Rep . 1988;103:189-195. 20. Rimer BK, Keintz MK, Kessler HB, Engstrom PF, Rosan JR. Why women resist screening mammography: patient-related barriers. Radiology . 1989;172:243-246.Crossref 21. Belcher DW. Implementing preventive services: success and failure in an outpatient trial. Arch Intern Med . 1990;150:2533-2541.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Feb 27, 1995

References